本文選題：生酮飲食　切入點(diǎn)：痙攣性癲癇　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]觀察生酮飲食(ketogenicdiet,KD)添加治療兒童痙攣性癲癇的臨床療效及不良反應(yīng)和依從性。[方法]對(duì)2015年5月至2017年1月在昆明醫(yī)科大學(xué)第一附屬醫(yī)院兒科及合作醫(yī)院接受KD添加治療的19例痙攣性癲癇患兒,通過(guò)臨床隨訪,根據(jù)Engel分級(jí)評(píng)價(jià)KD添加治療1、3、6個(gè)月的療效,記錄不良反應(yīng)、退出治療原因。同時(shí)分析并記錄以上各時(shí)間點(diǎn)腦電圖變化情況,指導(dǎo)并要求家長(zhǎng)對(duì)患兒語(yǔ)言、運(yùn)動(dòng)及行為的進(jìn)步或倒退進(jìn)行詳細(xì)觀察及記錄。[結(jié)果]19例以痙攣性發(fā)作為主要表現(xiàn)的癲癇患兒,男7例,女12例,年齡3個(gè)月至5歲5個(gè)月,KD添加治療1、3、6個(gè)月的總有效率分別為78.9%、77.8%、86.7%,其中完全控制發(fā)作分別有3例、4例、4例,完全控制發(fā)作率(I級(jí))分別為15.8%、22.2%、26.7%,KD添加治療療效與治療時(shí)間、年齡、性別差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。KD添加治療1、3、6個(gè)月后腦電圖好轉(zhuǎn)率分別為31.6%、72.2%、86.7%,不同時(shí)間腦電圖變化差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),KD添加治療3個(gè)月患兒不同EEG變化,其臨床療效差異有統(tǒng)計(jì)學(xué)意義(P0.05)。KD添加治療6個(gè)月后共有15例發(fā)育進(jìn)步,其中11例伴有大運(yùn)動(dòng)能力進(jìn)步,5例認(rèn)知功能改善,4例出現(xiàn)語(yǔ)言能力進(jìn)步。主要不良反應(yīng)為消化道癥狀,均較輕微,無(wú)嚴(yán)重不良反應(yīng)。治療療程大于6個(gè)月者15例,目前13例仍繼續(xù)治療,其余6例因短期治療無(wú)效、飲食不耐受、消化道癥狀等原因終止治療。[結(jié)論]KD添加治療對(duì)痙攣性癲癇治療安全有效,起效快。超過(guò)85%的發(fā)作減少,發(fā)育進(jìn)步15例。目前尚未觀察到嚴(yán)重不良反應(yīng)。還需要加強(qiáng)生酮飲食管理,改善飲食配方,加強(qiáng)健康宣教,提高患兒及家屬的依從性,從而對(duì)更大樣本進(jìn)行更長(zhǎng)時(shí)間臨床觀察,為痙攣性癲癇患兒提供更合適更有效的治療方案。
[Abstract]:[objective] to observe the clinical efficacy, adverse reactions and compliance of ketogenic dietate (KD) supplementation in the treatment of children with spastic epilepsy. [methods] from May 2015 to January 2017, pediatrics and cooperative hospital of the first affiliated Hospital of Kunming Medical University were selected. 19 children with spastic epilepsy received KD adjunctive therapy, According to the clinical follow-up, according to the Engel grade to evaluate the curative effect of KD plus therapy for 3 months and 6 months, to record the adverse reactions and the reasons for withdrawing from the treatment. At the same time, to analyze and record the changes of EEG at the above time points, and to instruct and request parents to speak the children's children. Movement and behavior progress or regression were observed and recorded in detail. [results] 19 epileptic children with spasmodic hair as the main manifestation, 7 males and 12 females, The total effective rates were 78.9% 77.8% and 86.7% respectively for 3 months to 5 months old and 5 months old and 5 months old, respectively. Among them, 3 cases (4 cases) with complete control attack, 4 cases with complete control attack rate (grade I) were 15. 8% 22. 2% and 26. 7% of the total effective rate, respectively, and the curative effect and treatment time, age, and age of addition therapy were 15. 8% and 22. 2% respectively. There was no significant difference in sex between the two groups. The improvement rate of EEG after 6 months was 31.6% and 72.2%, respectively. There was no significant difference in EEG changes at different time points. There were significant differences in clinical efficacy between 15 patients with developmental progress after 6 months of P0.05N. KD adjunctive therapy. Among them, 11 cases were accompanied with great motor ability improvement and 5 cases with cognitive improvement and 4 cases with language improvement. The main adverse reactions were digestive tract symptoms. The course of treatment was longer than 6 months in 15 cases, 13 cases were still treated, the remaining 6 cases were not effective because of short-term treatment, and the other 6 cases were not tolerant to diet. [conclusion] KD adjunctive therapy is safe, effective and effective in the treatment of spastic epilepsy. There are 15 cases of developmental progress. At present, no serious adverse reactions have been observed. It is also necessary to strengthen the management of ketone diet, improve diet formula, strengthen health education, and improve the compliance of children and their families, so as to conduct long-term clinical observation on a larger sample. To provide more appropriate and effective treatment for children with spastic epilepsy.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 朱登納;王明梅;王軍;袁俊英;牛國(guó)輝;張廣宇;孫莉;熊華春;謝蒙蒙;趙云霞;;生酮飲食添加治療兒童難治性癲癇的臨床觀察[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2016年01期

2 廖建湘;;生酮飲食療法在難治性癲癇中的應(yīng)用[J];中國(guó)實(shí)用兒科雜志;2016年01期

3 拜世英;馬艷紅;;生酮飲食治療兒童難治性癲癇的療效和不良反應(yīng)[J];臨床兒科雜志;2015年10期

4 顧碩;王治平;鮑南;俞宏真;葉曉來(lái);顧頡;李斐;周鶯;洪莉;殷敏智;宋云海;范家俊;徐敏;;多學(xué)科協(xié)作模式診斷和治療兒童藥物難治性癲癇研究[J];中國(guó)實(shí)用兒科雜志;2014年12期

5 朱登納;謝蒙蒙;王俊輝;王軍;馬德有;孫莉;李林琛;王明梅;;生酮飲食添加治療兒童難治性癲vN的前瞻性研究[J];中國(guó)當(dāng)代兒科雜志;2014年05期

6 盧忠英;郁莉斐;龔曉妍;王新華;華海梅;張林妹;周水珍;;兒童難治性癲癇生酮飲食治療依從性與安全性分析[J];中國(guó)實(shí)用兒科雜志;2013年05期

7 陽(yáng)衡;伍炯星;郭韌;彭毓h，

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